Provider Demographics
NPI:1184094179
Name:HOLDER, KYANA R (APRN)
Entity type:Individual
Prefix:
First Name:KYANA
Middle Name:R
Last Name:HOLDER
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:KYANA
Other - Middle Name:R
Other - Last Name:WEHRLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4239 FARNAM ST STE 100
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68131-2858
Mailing Address - Country:US
Mailing Address - Phone:402-552-2320
Mailing Address - Fax:402-552-2330
Practice Address - Street 1:4239 FARNAM ST STE 100
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68131-2858
Practice Address - Country:US
Practice Address - Phone:402-552-2320
Practice Address - Fax:402-552-2330
Is Sole Proprietor?:No
Enumeration Date:2015-10-02
Last Update Date:2015-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE111872363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner